Transcript Applying CDI to Home Management of Malaria

CDI Module 6: Applying CDI to Home
Management of Malaria
©Jhpiego Corporation
The Johns Hopkins University
A Training Program on CommunityDirected Intervention (CDI) to Improve
Access to Essential Health Services
Module 6 Objectives
By the end of this
module, learners will:
 Outline the three
components of malaria
case management
 Describe the processes
of case management
with
 Children
 Pregnant women
2
Three Essential Components of Malaria
Case Management
1.
Parasitological
diagnosis by
lab/slide or
RDT
3.
Counseling to
ensure
adherence
2.
Treatment with
recommended
drug (e.g.,
ACT)
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Benefits of Early Diagnosis and Treatment
of Malaria Illness
Enabling sufferers of malaria to have access to
efficacious and appropriate drugs within 24 hours
of onset of illness can reduce the:
 Duration of the illness (morbidity)
 Chances of progressing to severe malaria
(death)
 Probability of developing gametocytes (the form
in which transmission takes place)
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Diagnosis
Malaria classification includes:
Taking the patient’s brief history
Checking for fever
Checking for anemia (check the eyes and palms)
Checking for other signs of non-malarial illness with
fever
 Performing a rapid diagnostic test (RDT)
 Taking the patient’s body weight (to determine the
amount of medicine to give)
 Recording and documenting, on paper, all you have
observed
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Types of Malaria
 Uncomplicated
 Most common
 Severe
 Life threatening, can
affect brain
Decerebrate rigidity in complicated
(cerebral) malaria
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Treating Malaria in Children
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Recognizing Malaria
How do you recognize malaria?
 A child with malaria will have fever—fever simply
means hotness of the body
 You can recognize a child with fever:
 By touching the chest/body with the back of your
hand
 If the child’s caregiver says the child had fever before
coming, or
 If the axillary (armpit) body temperature is 37.5° C or
higher
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Other Symptoms
 In addition to fever, other manifestations of malaria
may include:
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Refusal to feed
Generalized body weakness
Not playing actively as usual/feeling unwell
Excessive sweating
Shivering and cold
Vomiting
Aches and body pains
Bitterness in the mouth
 NOTE: In the absence of an RDT or a lab test, a
child who has fever—but none of the other
symptoms—has malaria
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Steps to Take When a Child
Comes with Fever
Step 1
 Assess fever
 A patient has fever if he or she has:
– History of fever
– Feels hot or
– Has axillary temperature of 37.5° C and above
 Then ask how long he or she has had fever
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Recognizing Severe Malaria
 Malaria can be
serious—severe
malaria can lead to
disability or even
death
 A patient with severe
malaria presents with
general danger
signs, in addition to
fever
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Danger Signs
The following are the general danger signs:
 Convulsions
 Loss of consciousness/coma
 Vomiting everything/severe vomiting
 Child not able to drink or breastfeed
 Very sick child (unable to sit or stand)
 Difficulty in breathing or fast breathing
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Steps to Take When a Child
Comes with Fever (continued)
Step 2
 Check for general
danger signs
 Ask:
 Has the patient had
convulsions?
 Is the patient able to
drink or eat—or
breastfeed (if a child)?
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What Can We Observe?
Look to see if the patient:
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Is lethargic or unconscious
Is convulsing now
Has severe paleness/pallor (e.g., very pale palms)
Has difficulty in breathing (fast breathing)
Is passing dark or little urine
Has jaundice (yellowing of eyes)
Has abnormal bleeding
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How Can We Be Sure?
Microscopy and RDTs
 Unless we test for
actual malaria
parasites, we cannot
be sure the person
has malaria
 We will address how
to perform RDTs in a
later module
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Other Signs and Other Diseases
 Look and feel for
other signs that may
indicate another
disease that needs
different treatment:
 Stiff neck
 Running nose
 Signs of measles
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Steps to Take When a Child
Comes with Fever (continued)
Step 3
 Classify fever
 The two possible classifications for fever in a
malarious area are:
 Very severe febrile disease (febrile = with fever)
 Malaria
 Please give examples of other non-malarial
febrile diseases
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Classifying Malaria
Look at the table in your job aid and classify the
following case:
 If a patient has a general danger sign, stiff neck, or
symptoms or signs of severe malaria (passing dark or
little urine, jaundice, severe dehydration or difficulty in
breathing, abnormal bleeding), then the patient has:
 Severe malaria—please refer immediately
 If the patient has only fever without general danger
signs, classify as:
 Mild malaria—please treat
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Treating Malaria in Children
 Artemisinin-based
combination therapies
(ACTs) are recommended
medicine for uncomplicated
malaria
 For dosage of
artemether/lumefantrine
(Coartem), see the picture
on the right and the chart on
the next slide
 For dosage of paracetamol
as supportive treatment,
see the next slide
 Always read medicine
packet for exact dosing
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Treatment Chart
Dosage for Most ACTs (see packet for details)
Weight
Age
Number of tablets/dose
5–14kg
1 tab twice daily X 3 days
15–24kg
6 months to 3
years
4–8 years
2 tabs twice daily X 3 days
25–34kg
9–14 years
3 tabs twice daily X 3 days
≥ 35kg
> 14 years
4 tabs twice daily X 3 days
Supportive Therapy: Dosage for Paracetamol
Age Group
Amount
•2‒24 months
(125mg) give (1/4 tab)
•2‒6 years
(250mg) give (1/2 tab)
•>6‒12 years
(500mg) give (1 tab)
•>12 years
(500mg) give (2 tabs)
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Treating Malaria in Children—
Dosing Caution
Note: These drugs stay
in the body for a long
time
So, to avoid overdosing:
 A child—who had a
complete course of
appropriate ACT in the
same month, and is
now presenting again
with fever, should be
referred
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TIPS on Counseling for Malaria Medicines
 New Coartem will dissolve in water
 If using artesunate-amodiaquine (AA) for children
less than one year of age, you may need to crush
the tablet
 Mix banana or honey with the crushed medicine
to sweeten it (discuss)
 Make sure the child eats some food before taking
medicine
 Fatty foods help the body absorb medicine
 If the child vomits within 30 minutes of swallowing
the medicine, please repeat that vomited dose
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More Tips
If the child begins to react to the medicine, take
him/her to the health facility immediately
Reactions may include:
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Rashes and itching
Difficulty breathing/cough
Restlessness
Other behavior or manifestation the caregiver
considers unusual
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How to Prevent Onset
of Danger Signs at Home
 Give the child correct treatment immediately
when you notice illness and ensure that the child
completes the full dose
 Bring down fever immediately by:
 Undressing the child and fanning him/her
 Bathing the child with lukewarm or tepid water
 Giving the appropriate dose of paracetamol
 Giving the child enough fluid
 If the child is not responding to treatment, take
him/her to a health center immediately
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Convulsions
 What is convulsion?
 When the whole or part of the child’s body begins to
make repeated jerky movements
 In small children, convulsion is usually caused
by a sudden rise in body temperature
 What to do?
 See next slide
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What to Do If Convulsion Occurs
 Loosen all tight clothing, and leave only light
clothing on the child
 Disperse the crowd
 Keep the child isolated
 Lay the child flat on the floor
 Remove any dangerous objects around the child
 Take the child to a health center as soon as
possible
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Treatment Challenges—
What If It Is Not Malaria?
 When we involve the community in delivering
integrated community case management (iCCM),
we are creating expectations that communitydirected distributors (CDDs) and other volunteers
will be able to address common illnesses
 If our diagnosis using signs, symptoms and RDTs
does not find that a fever is caused by malaria:
 We have (it is hoped) included treatment of
pneumonia in our iCCM package
 Fever could be caused by something other than
malaria, and our CDDs will need to refer people when
the cause of their fever is not clear
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Treating Malaria in Pregnancy
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Benefits of Treatment
Treat malaria in pregnancy (MIP) quickly and correctly to
prevent:
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Anemia in pregnancy
Miscarriage
Fetal growth retardation
Low birth weight
Stillbirth
Greater likelihood of
death in the neonatal
period
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Recognizing Malaria in Pregnant Women
Uncomplicated Malaria
 Fever (hot body)
 Shivering/chills/rigors
 Weakness
 Headaches
 Muscle and/or joint pains
 Nausea with or without vomiting
 False labor pains
 Mild anemia
 Loss of appetite
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Common Signs of Malaria
Some common signs of
malaria are:
 Axillary temperature of
37.5° C or higher
 Anemia (pallor of the mucus
membrane or palms)
 Enlarged spleen and/or liver
If any one or more of these
symptoms and signs are
found:
 Malaria should be
considered
 Use RDT and follow the
results
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Malaria in Different Transmission Settings
 In highly endemic,
stable, year-round
malaria transmission
areas, a pregnant
woman may not
always exhibit the
typical clinical signs
due to some acquired
immunity
 RDTs are very helpful
in this situation
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Recognizing Severe Malaria
 Pregnant women are more likely to get severe
malaria than non-pregnant women
 Signs of uncomplicated malaria plus one or more of
the following indicate severe malaria:
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Dizziness
Breathlessness/difficulty breathing
Sleepiness/drowsiness
Confusion
Coma
Sometimes fits, jaundice, severe dehydration
Severe anemia
Pulmonary edema
 Again, always verify with an RDT
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Treating Malaria: Uncomplicated or Severe
 ACTs are the drug of choice for uncomplicated
malaria
 The most common ACTs are artemether-lumefantrine
and artesunate-amodiaquine
 ACTs are also recommended for the treatment of MIP
in most countries, but guidelines vary
 Quinine is also recommended for MIP and is
usually the drug of choice for severe malaria
 Facilitators will provide a handout for MIP
treatment in your own country
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Managing MIP
 Provide the drug of choice
for malaria according to
national guidelines
 Quinine in the first trimester
 ACT in the second or third
trimesters
 If the pregnant woman is in
her first trimester, refer her
to the health center in your
community
 Manage fever with
analgesics, tepid sponging
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Treating MIP
 Observe the client taking the first dose of antimalarial drugs
 Direct observation of treatment (DOT) strategy
ensures that medicines are not wasted
 Advise the client to:
 Complete the course of drugs
 Return if there is no improvement in 48 hours
 Consume iron-rich food (e.g., plantain, beans)
 Use long-lasting insecticide-treated nets
(LLINs)/insecticide-treated nets (ITNs) and other
preventive measures
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As Part of Treating MIP …
 Arrange follow-up within 48 hours of DOT
 Advise to return if condition worsens
 Educate on danger signs
 Reinforce use of LLINs/ITNs
Most clients will respond to malaria treatment and
begin to feel better within 48 hours; however:
 If the woman’s condition does not improve—or
worsens—within 48 hours of starting treatment,
and/or other symptoms appear, refer
immediately
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Summary
 Malaria case management has three essential
components—diagnosis, treatment and
counseling
 We should differentiate malaria from other
febrile illnesses and treat all illnesses correctly
 Look for danger signs to prevent cerebral
malaria (e.g., convulsions)
 Treat malaria in pregnant women to prevent
stillbirth, miscarriage and low birth weight
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In Conclusion
 If the person who is ill does not have malaria,
treat for appropriate illness or refer
 We will address two other illnesses, pneumonia
and diarrhea, in subsequent modules
 Any comments or questions please?
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